Fit Life

Why is it so hard to lose the last 10 pounds?

February 23, 2011

Weight loss is tricky in that multiple factors play into how much weight is lost, how quickly it comes off and for how long the weight loss is maintained. To successfully lose a sizeable amount of weight, a person needs to be committed to significant long-term lifestyle changes. The goal is to create a caloric deficit so that fewer calories are eaten than are expended. With about 3500 calories in a pound, a 500-calorie deficit each day through decreased food intake and increased physical activity leads to about a one-pound weight loss per week – initially. By simply making relatively minor lifestyle changes [like cutting out that 20oz bottle of soda everyday (250 calories)] and taking the 45-minute, 2.5 mile walk each day (about 250 calories), you could drop a few pounds early on with little difficulty. But after a few weeks to months and several pounds later, continued weight loss becomes much more difficult.

A good analogy when considering the trials and tribulations of trying to lose significant amounts of weight is to compare weight loss to competing in a marathon. For those readers who have never participated in a marathon, and perhaps have no desire to ever do so, here are just a few basic pieces of information that you need for this analogy to make sense. The marathon principles are followed by a description of what each point has to do with losing those last 10 pounds. (Disclaimer: these are just generalizations that may not apply to every runner or person trying to lose weight.)

A marathon is 26.2 miles. An untrained and totally unprepared runner will “hit the wall” early on, most likely before the halfway mark and will most likely fail to finish the race either because of mentally giving up or physically becoming injured. A novice runner who has trained well will be ready to quit around mile 20 when the body starts to breakdown and the race becomes very uncomfortable, but this person will push through and finish the race. A highly-trained experienced marathoner will keep a steady pace throughout the long run and will finish the race at the top of the pack. This performance is a direct result of committed and well-designed physical training and a remarkable mental toughness.

Weight loss application: Anybody who is trying to lose significant amounts of weight has to be in it for the long haul. What that means is, you’ve got have a realistic weight loss plan with the full recognition that it takes time to lose weight. The lifestyle changes need to be ingrained and permanent – even a small deviance from the plan can derail weight loss and not only prevent future loss but also may lead gaining the weight back. This doesn’t mean that a person trying to lose weight will never get to eat a piece of chocolate cake again. What it does mean is that chocolate cake needs to be “built into the plan.” Adopting a fad diet will not lead to long-term weight loss success. For example, people who adopt very low-carbohydrate diets boast of significant early weight loss but after a year’s time, they are no better off than people who tried a different approach. The early weight loss was mostly water (and not fat) and the long-term outcome is dramatically slowed weight loss due to poor adherence to the eating plan. If you want to permanently lose weight, you’ve got to do it slowly and steadily through lifestyle changes that are maintained day in and day out just as you would train for a marathon by running four days per week for 18 weeks as you build up to the big day.

The human body was not designed to run such long distances. Story has it that the first marathoner was the Greek soldier Pheidippides who ran 25 miles to carry a message from the Battle of Marathon to Athens. He collapsed and died shortly after reaching his destination. With training and good nutrition and hydration, however, the body holds up very well. In 2010 a Belgian man ran a marathon for every day of the year -- 365 marathons in as many days.

Weight loss application: The human body doesn’t really like to be on a diet. Each of us has a steady-state weight that the body tries very hard to maintain. When we gain weight above that steady-state, the body attempts to increase caloric expenditure. When we lose a lot of weight, the body tries very hard to gain weight to get back to steady state. This is part of the reason the last 10 pounds are so hard to lose – while you are trying to lose more, the body is resisting and trying to put the weight back on by decreasing metabolism and increasing hunger. Most people who are overweight or obese at one point overrode the body’s initial steady state weight. And with a lot of effort you can achieve a new steady-state, but it requires a great deal of persistence and effective nutrition and physical activity strategies. A few tips:

Change up your endurance routine. The goal is to burn more calories. You can do this without increasing the amount of time spent on cardio by upping your intensity. Otherwise, you’re going to have to increase the amount of time committed to cardio whether that’s adding 15 or 20 minutes to your current routine or increasing the number of days per week.

Strength train at least twice per week. When you lose a lot of weight, about a quarter of weight loss comes from muscle if you don’t include a strength-training component to your workout routine. This helps explain why those last few pounds are so hard to lose. Your metabolism has slowed down and, therefore, you’re burning fewer calories at rest. The metabolic rate is directly linked to the amount of muscle you have – for every pound of lean muscle mass you burn about six calories per day. While that doesn’t sound like much, if you lost 20 pounds of fat and kept all of your muscle mass, the five pounds of muscle mass you kept (versus what you might lose without a resistance training program) would help you lose about three extra pounds. Maintain muscle mass while continuing to lose weight by committing to your resistance training routine.

Eat less. To have successfully lost weight in the first place you no doubt made some significant dietary changes. If you want to continue to lose weight, you’ll need to make further cuts. Assess your approximate daily caloric intake (mypyramidtracker.gov is a good place to start) and then come up with strategies to cut an additional 250 calories per day (provided that will still keep you at a healthy calorie level and not at risk for nutrient deficiencies). If you eat 250 calories less per day and do not make any changes to your exercise regimen, you’ll lose those last 10 pounds over the course of the next five months. If you exercise more, it will come off faster.

Anyone can finish a 5K or a 10K but not everyone can finish a marathon. It takes a high level of commitment and ongoing diligence to successful train for and compete in such a long race.

Weight loss application: Somewhere around 40% of women and 30% of men are trying to lose weight at any given time. Some are successful initially but most are unable to lose and keep off the weight. Losing weight is tough. Keeping it off requires a constant effort. Trying to lose even more – like those last 10 pounds – may seem impossible. To achieve and maintain your goal weight loss you’ve got to be in it for the long haul. Slowly and steadily progress to your goal with each of the small decisions you make every day – take the stairs instead of the elevator, go for the fresh apple instead of the apple pie… After all, being the first one done isn’t the goal, it’s just about having the strength, endurance, and mental toughness to successfully cross that finish line.

Natalie Digate Muth, MD, MPH, RD, FAAP is the Senior Advisor for Healthcare Solutions for the American Council on Exercise, a board-certified pediatrician and Fellow of the American Academy of Pediatrics, a Diplomat of the American Board of Obesity Medicine, registered dietitian and board-certified specialist in sports dietetics, and ACE Certified Health Coach. She is the author of "Eat Your Vegetables and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters" and the textbook "Sports Nutrition for Health Professionals." She has been ACE certified since 1998.

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